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A little girl receiving quality applied behavior analysis.

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Applied Behavior Analysis: Misconceptions and Quality Indicators

At the Autism Society of North Carolina, we believe that every autistic individual and their family has the right to high quality, person-centered, autism-informed services that recognize and value the individual’s neurodiversity.

For individuals and families who pursue applied behavior analysis (ABA), we encourage you to advocate for a provider offering modern ABA. ABA represents a range of systematically implemented strategies developed from the science of learning and behavior.¬†When it is at its best, ABA is person-centered instruction and support with the aim of improving quality of life for the individual.¬†‚Äč

Like any other field, ABA has evolved in recent decades. And like any other field, some professionals are evolving faster than others. There have been ‚Äď and are ‚Äď ongoing challenges with ABA.¬†Some families and autistic individuals have experienced or heard of ‚ÄúABA‚ÄĚ treatments that do not follow modern best practices. This article addresses some misconceptions about ABA, red flags to look out for, and indicators of a quality program.

Common Misconceptions on Applied Behavior Analysis

Misconception: ABA is only used as an autism intervention.

Behavior analysis is a science that goes far beyond autism intervention, and the origins of ABA were not in autism. ‚ÄčABA strategies and principles have been demonstrated to be effective with an array of issues, including education, addiction, mental health, gambling, exercise, organizational behavior management, environmental sustainability, memory impairment, physical health, and more.

Misconception: ABA is only for children.

Behavior analysis can be used to support the development of critical skills for learners of any age. Some insurance funders, including Medicaid, are recognizing this, as they now authorize ABA services for adults. ‚Äč

Misconception: ABA is incompatible with other therapies.

ABA is compatible with other treatments, including speech therapy, occupational therapy, and other evidence-based practices. Evidence-based practices in autism such as visual supports, modeling, and naturalistic teaching, can and in many cases should be integrated into an ABA program. One evidence-based approach does not have to be chosen over another.¬†‚Äč

Providers who insist that individuals and their families only receive ABA treatment and disregard the value of other treatment options should be avoided. If an individual is fortunate enough to have an interdisciplinary team of providers in their corner, clinicians should embrace this as an opportunity for collaboration rather than a roadblock to care.

Misconception: ABA happens at a table with repetitive learning drills.

‚ÄčSitting at a table, learning through flash card drills using materials unrelated to the skill they are learning is not high quality, modern ABA practice. Instead, you should see teaching occur through play-based interactions or in the context of functional routines. Quality ABA programs emphasize the most important skills for that person, in the environments that matter, using materials and activities that are most relevant for that person. Behavioral principles and strategies can be applied in schools, at the grocery store, in the workplace, at the coffee shop, at the swimming pool, in the kitchen, and so on.¬†Teaching in the right context ‚Äď one that makes sense for the skill and for the learner ‚Äď is an important key to long-term success.

‚ÄčMisconception: ABA is just about behavior reduction or challenging behavior.

An adult male receiving quality applied behavior analysis.

Behavior analysis can be used at any age.

ABA has evolved towards a more client-centered approach that is focused on¬†building the skills¬†that will help the individual become their own best self-advocate, to live with dignity and safely while achieving a quality of life as defined by the individual and their family. When challenging behavior is happening, it is communicating a message to us; it expresses an unmet need. The goal is to teach the individual better ways to get those needs met.¬†‚Äč

Treatment plans that emphasize compliance are to be avoided.¬†In order to celebrate neurodiversity and to affirm the perspectives and opinions of our autistic clients, it’s important that ABA programs emphasize empowerment and self-advocacy. Teaching compliance as a focal point of ABA treatment is not only irresponsible and unethical but can also be dangerous to the individual receiving services and can lead to long term negative outcomes. It’s important that we view treatment as an opportunity to teach skills that give members of the autism community more of a voice, with effective ways to express their opinions and preferences. Learning to protest, to say “no,” and even to question authority in safe and effective ways is a safety skill that is important in both childhood and adulthood.‚Äč

On that note, individuals learn best when they feel empowered rather than intimidated. Programs that emphasize only instructor-led goals, activities, and ideas are to be avoided because the autistic individual is not affirmed through that model of teaching, and the outcomes will not be person-centered or as meaningful as those that result from a client-led, individualized approach.

Misconception: Only BCBAs can use behavior analytic strategies.

For autism treatment and support, Board Certified Behavior Analysts (BCBAs) are master’s and PhD-level professionals who oversee the intervention program. But BCBAs and the registered behavior technicians (RBTs) that they supervise are not the only people who can apply behavior analytic strategies. Caregivers can¬†use these strategies in their natural routines and interactions with their child. Effective classroom teachers use many tools and strategies that are drawn from the science of behavior analysis.

The time spent in ABA sessions working directly with BCBAs and RBTs is obviously a crucial component of the treatment package. However, your treatment team’s primary goal from the onset of services should be to teach not only the individual receiving services but also to collaborate with their primary caregivers and support systems to ensure that the strategies that have been found to be successful in sessions can be carried over and used outside of sessions.

Misconception: Everyone needs many hours of ABA each week for it to be effective.

Not all individuals need a high number of treatment hours per week to make progress. In fact, this can often be contraindicated and harmful to progress if the number of sessions prescribed is higher than the actual need. One major red flag when searching for an ABA provider is a blanket dosage recommendation or service hour minimum. High quality providers will first conduct an assessment and seek to understand the routines and schedules of your family. Then, they will make a recommendation based on need and the stamina/engagement level of the individual. Recommendations should be individually tailored, just like other aspects of treatment planning.¬†‚Äč

 

Quality Indicators

Though ABA services can (and should) look different from person to person, there are several indicators of well done, modern ABA that families and individuals should look for in evaluating the quality of a program.‚Äč

What is quite possibly the most important element of high-quality services is the person-centered nature of the treatment plan, goals, and teaching procedures. When ABA is done well, the clinician takes the time to truly learn about the preferences and personal goals of the individuals they are serving. This starts with the assessment process and can be done by spending time with the individual and the people who are most important to them, including family members and teachers. It should be clear in reading the treatment plan that the clinician has incorporated information provided by the individual receiving services and their family to develop goals that truly matter to the individual.

This person-centered approach should be carried through treatment in intentional ways, such as using child-led play to teach young learners or activities that incorporate interests and preferences for adolescents and adults. It is also important that ABA practitioners strive to be trauma-informed and culturally responsive in their teaching approaches and strategies.¬†‚ÄčHigh quality, modern¬†ABA upholds the values of the individual and their family at all times.

And of course, in order to provide both person-centered and values-based care, clinicians must acknowledge neurodiversity as part of their practice and design programs that affirm the unique perspectives and characteristics of each of their autistic clients. This means that clinicians ensure that their primary goal is not to change the person with autism or to promote conformity to neurotypical standards or perspectives. High quality, modern ABA does not promote masking (or hiding characteristics of autism). Instead, it should highlight self-advocacy and empowerment so that autistic individuals learn new skills that get them closer to their individually determined goals.¬†‚Äč

These elements come together to create treatment sessions that look and feel natural¬†and enjoyable for the individual. ABA¬†sessions will look different from individual to individual based on their age, goals, and treatment setting. However, there is one common thread with high quality ABA programs ‚Äď the individual receiving services should be¬†happy,¬†relaxed,¬†and engaged¬†with their treatment team. This doesn’t mean that the sessions aren’t challenging at times as the individual learns new skills. But learning cannot happen through stress, tears, or power struggles.‚Äč

In essence, ABA treatment programs and all interactions that occur within ABA sessions should uphold various fundamental rights of individuals with autism. These include, but are not limited to: the right to be valued and heard, to express their opinions and interests, to say “no,” to protest, and to negotiate. The right to safety and privacy. The right to move one’s body to feel calm and relaxed. To explore meaningful vocational and social opportunities. And the right to receive¬†accommodations, supports, and validation.¬†‚Äč

 

For more information about high quality ABA, including a list of questions to ask potential ABA providers, please visit our treatment page. The Autism Society of North Carolina is an ABA provider in the Asheville, Chapel Hill, Durham, Raleigh, and Wilmington areas. To learn more about ABA services at the Autism Society of North Carolina, click here.

This article previously appeared in the Summer 2023 issue of Spectrum. It is adapted from this webinar: ABA – The Good, the Bad, and the Progress.

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